Provider Demographics
NPI:1669425245
Name:THORNBURG, AARON T (DO)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:T
Last Name:THORNBURG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 N 2ND ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 N 2ND ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2369
Practice Address - Country:US
Practice Address - Phone:602-274-7195
Practice Address - Fax:602-274-7097
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5017207RC0200X, 207RP1001X
WI100-321207RC0200X
IN02002916A207RP1001X
CA20A16041207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ332020Medicaid
IN000000550239OtherBCBS PIN
INI17120Medicare UPIN
IN200840300Medicaid
INP00371012Medicare PIN
IN165460QQQQMedicare PIN
IN000000550239OtherBCBS PIN